Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval.
Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Registered Nurse with active MI state license in good standing.
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise.
Excellent analytical and problem-solving skills.
Effective communications, organizational, and interpersonal skills.
Ability to work independently.
Effective computer skills including navigating multiple systems and keyboarding.
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint.

Case Manager, Registered Nurse - Field MI

Key skills